Provider Demographics
NPI:1669598496
Name:RHODES SCHOOL DISTRICT 84.5
Entity type:Organization
Organization Name:RHODES SCHOOL DISTRICT 84.5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WIERZBICKI
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:708-453-1266
Mailing Address - Street 1:8931 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60171-1810
Mailing Address - Country:US
Mailing Address - Phone:708-453-1266
Mailing Address - Fax:
Practice Address - Street 1:8931 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60171-1810
Practice Address - Country:US
Practice Address - Phone:708-453-1266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid